Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DDS-09245 | IA |
N | 1223P0106X | Oral and Maxillofacial Pathology | DN122241 | GA |
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS042724 | PA |
NPI | 1164899423 |
---|---|
Provider Name | Dr. Scott Michael Steward-Tharp |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2015 |
Last Update Date | 15/04/2021 |